Shenzhen Children's Medical Insurance Reimbursement Scope

Legal analysis: (1) Drugs belonging to Class A and Class B of the basic medical insurance drug list are paid by the community outpatient co-ordination fund according to the proportion of 80% and 60% respectively; (two) individual medical items or medical materials belonging to the basic medical insurance catalogue shall be paid by the community outpatient co-ordination fund for 90%, but the maximum payment amount shall not exceed 120 yuan. The outpatient medical expenses paid by the community outpatient co-ordination fund to each second-and third-level insured person of basic medical insurance within a medical insurance year shall not exceed 1000 yuan at the highest. The new social medical insurance for residents integrates the original new rural cooperative medical system and the original basic medical insurance for urban residents. Urban and rural children have achieved unified payment, unified subsidy and unified treatment, and the overall level of children's medical security in the city has been further improved. The maximum annual guarantee for children's social medical insurance benefits is more than 880,000 yuan, of which the maximum annual guarantee for basic medical insurance is 6.5438+0.8 million yuan, the maximum annual guarantee for serious illness medical insurance is 600,000 yuan, and the maximum annual guarantee for serious illness medical assistance is 6.5438+0.8 million yuan. For the children of the original urban residents, the new social medical insurance for children has increased the fund-raising business of outpatient co-ordination, and minor outpatient illnesses can also be reimbursed, so that the medical insurance for children is more comprehensive. General outpatient medical expenses incurred by insured children in contracted designated community medical institutions (including community health service centers, community health service stations, town hospitals, village clinics, etc.). In line with the scope of outpatient co-ordination payment, the basic medical insurance co-ordination fund will pay 40%, of which the basic drugs will pay 50%, that is to say, urban and rural children will see a doctor in primary medical institutions, and the maximum payment will be 300 yuan a year.

Legal basis: People's Republic of China (PRC) Social Insurance Law.

Twenty-eighth medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency treatment and rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Twenty-ninth medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by the social insurance agency, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.